Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure
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PurposeThe present study aimed to analyze the impact of perioperative fluid management on postoperative ileus (POI) after loop ileostomy closure.MethodsConsecutive loop ileostomy closures over a 6-year period (May 2011-May 2017) were included. Main outcomes were POI, defined as time to first stool beyond POD 3, and postoperative complications of any grade. Critical fluid management-related thresholds including postoperative weight gain were identified through receiver operator characteristics (ROC) analysis and tested in a multivariable analysis.ResultsOf 238 included patients, 33 (14%) presented with POI; overall complications occurred in 91 patients (38%). 1.7L IV fluids at postoperative day (POD) 0 was determined a critical threshold for POI (area under ROC curve (AUROC), 0.64), yielding a negative predictive value (NPV) of 93%. Further, a critical cutoff for a postoperative weight gain of 1.2kg at POD 2 was identified (AUROC, 0.65; NPV, 95%). Multivariable analysis confirmed POD 0 fluids of >1.7L (OR, 4.7; 95% CI, 1.4-15.3; p=0.01) and POD 2 weight gain of >1.2kg (OR, 3.1; 95% CI, 1-9.4; p=0.046) as independent predictors for POI.ConclusionsPerioperative fluid administration of >1.7L and POD 2 weight gain of >1.2kg represent critical thresholds for POI after loop ileostomy closure.
Langenbeck's Archives of Surgery, vol. 404 (1), pp. 39-43